头痛宁胶囊治疗偏头痛60例疗效观察

目的 观察头痛宁胶囊防治偏头痛的疗效.方法 将120例门诊偏头痛患者随机分为对照组和治疗组,每组60例,对照组采用西比灵口服治疗,治疗组采用头痛宁胶囊治疗,两组均以4周为1个疗程.治疗前后观察2组在头痛持续时间、发作频率、头痛强度等方面的改善情况,并比较疗效.结果 经过1个疗程的治疗,总有效率治疗组为91.7%,对照组为66.7%,2组比较差异有统计学意义（P＜0.05）.结论 头痛宁胶囊口服治疗偏头痛,在减轻头痛程度、缩短头痛持续时间等方面疗效较好,且无明显的不良反应.     

Treatment of Chronic Migraine with OnabotulinumtoxinA: Mode of Action,Efficacy and Safety

Background: Chronic migraine is a common, highly disabling, underdiagnosed and undertreated entity of migraine. It affects 0.9%–2.2% of the general adult population. The present paper overviews the preclinical and clinical data regarding the therapeutic effect of onabotulinumtoxinA in chronic migraineurs. Methods: A literature search was conducted in the database of PubMed up to 20 May 2015 for articles related to the pathomechanism of chronic migraine, the mode of action, and the efficacy, safety and tolerability of onabotulinumtoxinA for the preventive treatment of chronic migraine. Results: The pathomechanism of chronic migraine has not been fully elucidated. The mode of action of onabotulinumtoxinA in the treatment of chronic migraine is suggested to be related to the inhibition of the release of calcitonin gene-related peptide and substance P in the trigeminovascular system. Randomized clinical trials demonstrated that long-term onabotulinumtoxinA fixed-site and fixed-dose (155–195 U) intramuscular injection therapy was effective and well tolerated for the prophylactic treatment of chronic migraine. Conclusions: Chronic migraine is a highly devastating entity of migraine. Its exact pathomechanism is unrevealed. Two-third of chronic migraineurs do not receive proper preventive medication. Recent clinical studies revealed that onabotulinumtoxinA was an efficacious and safe treatment for chronic migraine.     

The relevance of migraine in patients with Ménière's disease

Conclusion. Coexistent migraine affects relevant clinical features of patients with Ménière's disease (MD). Objective. Epidemiological studies have shown an association between migraine and MD. We sought to determine whether the coexistence of migraine affects any clinical features in patients with MD. Patients and methods. In this retrospective case-control study of University Neurotology Clinic patients, 50 patients meeting 1995 AAO-HNS criteria for definite MD were compared to 18 patients meeting the same criteria in addition to the 2004 IHS criteria for migraine (MMD). All had typical low frequency sensorineural hearing loss and episodes of rotational vertigo. Outcome measures included: sex, age of onset of episodic vertigo or fluctuating hearing loss, laterality of hearing loss, aural symptoms, caloric responses, severity of hearing loss, and family history of migraine, episodic vertigo or hearing loss. Results. Age of onset of episodic vertigo or fluctuating hearing loss was significantly lower in patients with MMD (mean±1.96*SE=37.2±6.3 years) than in those with MD (mean±1.96*SE=49.3±4.4 years). Concurrent bilateral aural symptoms and hearing loss were seen in 56% of MMD and 4% of MD patients. A family history of episodic vertigo was seen in 39% of MMD and 2% of MD patients.     

ACAM2000: a newly licensed cell culture-based live vaccinia smallpox vaccine

Importance of the field: Migraine is an episodic, substantially inherited brain disorder affecting 15% of adults in Western Europe and North America, and is one of the commonest reasons for patients to see their physicians. While the World Health Organization considers that severe migraine can be as disabling as quadriplegia, unfortunately the condition remains undertreated. Until the 1990s, specific migraine therapies were limited to ergot derivatives.

Areas covered in this review: The triptans, serotonin 5-HT_1B/1D receptor agonists, revolutionized the acute management of migraine patients. However, although the triptans are generally effective and safe, not all patients can take them and many do not respond especially to oral therapies. Recently, progress has been made on the therapeutic front, particularly with new acute treatments. This review will focus on the therapeutic potential of ADX10059, a metabotropic glutamate receptor 5, negative allosteric modulator (mGluR5 NAM), in migraine. Data from a proof-of-concept study in episodic migraineurs demonstrated a significant improvement following acute treatment. A large European multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-ranging study is currently investigating the efficacy, safety and tolerability of the compound for migraine prevention.

What the reader will gain: The reader will have the basic principles of migraine management and the potential for glutamate-targeted approaches.

Take home message: Targeting glutamatergic transmission in migraine may provide a novel preventive therapy that is effective and well-tolerated.     

散偏汤加减治疗偏头痛研究进展

偏头痛是一种常见的神经血管功能紊乱性疾病，多表现为反复发作的单侧或两侧剧烈头痛，偶伴恶心、呕吐、畏光、畏声等症状，具有反复发作、家族遗传的特点。中医认为偏头痛属于“头风”范畴，其发病多由外风引动导致，且与肝风内动有关。散偏汤出自清代医家陈士铎所创《辨证录·头痛门》，由川芎、白芷、郁李仁、香附、柴胡、白芥子、甘草组成，具有行气止痛，活血化瘀的作用，临床上常用于治疗偏头痛。目前应用散偏汤治疗偏头痛的临床研究多使用原方加减用药，或单独应用，或与西药/针刺联合应用。临床试验结果显示可以明显降低偏头痛积分、疼痛视觉模拟评分及内皮素水平等，减少止痛药使用频率，改善偏头痛症状显著且不良反应少。动物实验多从偏头痛发病不同解剖水平上探究散偏汤加减的起效机制，主要有降低一氧化氮（NO）、一氧化氮合酶（NOS）水平，减少神经递质的释放如5-羟色胺（5-HT）、神经肽（NPY），抑制神经元兴奋，阻断伤害性感受传导通路的传递，进而促进脑血液循环，调节神经递质而达到防治偏头痛的作用。该文结合偏头痛的发病机制，对散偏汤加减的临床应用、实验研究等方面的最新进展进行了系统综述，总结其防治偏头痛的作用机制，为临床治疗偏头痛提供新的思路。